Lack of doctors plague small communities

November 20, 2012

LANSING - The state's physician shortage has an adverse impact on smaller rural counties like Crawford and Roscommon while the demand for physicians nationwide remains high.

According to the Department of Community Health, more than 10 counties are categorized as health professional shortage areas, including Wexford, Gladwin and Crawford.

These areas have "significant need for additional primary health care resources," according to the department.

Article Photos

Although some small communities in Michigan are finding it difficult to recruit physicians, several downstate locations are recruiting doctors who grew up in that area. (File photo)

Jessy Sielski, director for communications of the Michigan State Medical Society, said the society advocates increased funding for medical residencies in Michigan and support.

Mercy Hospital Grayling's chief business development officer, Bryan Lydick, said its medical staff is comprised of physicians practicing in two counties - Crawford and Roscommon.

Lydick said, "It is getting harder and harder to recruit physicians and the patients need somewhere to go."

According to the Michigan Academy of Family Physicians, 45 percent of Michigan's physicians plan to retire in the next 10 years and the largest shortage is in primary care.

The academy's president, Christopher Bush, said, "The key to our organization's survival is to increase our family physicians - it's always been difficult to attract medical students into primary care residency programs.

"Not only do medical students not have good family physician role models but they spend very little time with us - maybe one month in their third year," Bush said.

Bush said most of the training for medical students is in academic centers and hospitals where they are exposed to specialists and students become enamored by the prestige.

"Also, the medical student debt is fairly insurmountable maybe more than $200K to pay back after their training," Bush said, "and students facing this debt say they have to go into something that pays well."

Mary Neff, chief operating officer for Mercy Hospital Cadillac, said there are a limited number of physicians who want to practice in rural areas.

"We have needs that we're not able to meet in both primary care and specialty services," she said.

Citing a combination of answers why specialty physicians don't want to practice in rural areas, she said, "Physicians in a smaller environment are on-call more and sometimes the compensation is lower."

Many surgeons coming out of a residency program are highly specialized which lends itself to jobs in larger medical centers, she said.

"Sometimes it is because technology is available at larger centers but not in smaller ones."

Sielski said, "The best way to keep new physicians in Michigan is by increasing the residency slots in Michigan. Until this happens, we'll simply be exporting medical students/residents to other states, where they are more likely to settle."

Neff said, "We have broadened our referral network," and so when her hospital has specialty shortages, those physicians send patients to partners in places like Munson, Grand Rapids or Spectrum and other hospitals.

Mercy Hospital Cadillac recently lost a primary care physician because of family preference and then had both primary care physicians and specialists retire, she said.

One general surgeon was replaced but the hospital is recruiting more primary care physicians, Neff said.

"It's just tough to recruit because it's a rural market," she said, and because the demand is high everywhere, physicians have a lot of opportunities to choose from.

Bush said some family physicians choose to be trained on more procedures such as delivering babies, colonoscopies and certification to practice sports medicine.

"Training is unlimited, but you just have to pursue it," he said.

Many doctors have to close their offices, Bush said, because "for many health plans, the reimbursement is less than the cost of the care provided. Medicaid may pay 30 percent of the cost of providing that office visit or surgery but doctors cannot afford to take many patients from that type of plan because it doesn't make sense economically."

One way hospitals can narrow the physician shortage is to recruit locally.

Lydick said Mercy Grayling works closely with the schools in its service area, so when students are interested in medical school, "we try to 'grow our own' and offer back education incentives within our system."

Neff said a Cadillac physician who was raised and went to school in Cadillac, later returned and opened a pediatric practice there.

Lydick also said Mercy Hospital Grayling supplements its physicians with mid-level providers such as nurse practitioners and physician assistants to support those they do have.

Neff also said some primary care physicians in Cadillac are expanding their access to patients by hiring nurse practitioners or physician assistants.

"I think that's been very helpful and it's a good model and we will see much more of that, either independent practices for nurse practitioners or partnerships with physicians."

"And when there aren't enough primary care physicians to take care of a population, people seek more expensive care, like the emergency room," Neff said. That creates a volume issue when ERs become crowded and it is much more expensive than office treatment.